6.2 A Hypothetical Mental Patient

Let us try to get a feeling for the human
side of this problem by sketching the profile of a hypothetical mental patient.
We’ll call the patient Kerry. Kerry is a young person who has always felt a
little bit different from other people, perhaps because of a heightened feeling
of vulnerability or self-consciousness. Kerry has long held a passion for
poetry and eastern religions, and recently he/she began to find new meaning in
favourite writings. After sitting up all one night reading, he/she slipped into
an altered state of consciousness involving visions and voices. When Kerry
began to express unusual beliefs to the family over the next few days, together
with fragmented quotations of poetry referring to ‘slings and arrows of
outrageous fortune’ and taking ‘arms against a sea of troubles’, the family
doctor was called in to make an examination. The doctor identified delusions,
and thought Kerry was in need of care, treatment, and control. This led to
Kerry’s involuntary admission into a mental hospital.

DSM-IV defines delusions as false beliefs
that are not ‘ordinarily accepted by other members of the person’s culture or
subculture’.[18] This means
that Kerry’s family doctor, by virtue of being a medical practitioner, is
presumed under the sanctions of typical mental health legislation to be a
competent judge of ordinarily accepted beliefs and is empowered to certify
anyone who appears to hold beliefs that he/she thinks are culturally
unacceptable.

It should be remembered that after Kerry’s
incarceration in a hospital there are still no laboratory tests available to
confirm an underlying cause for the delusions identified by the family doctor.
The hospital psychiatrists would therefore have to rely on monitoring Kerry’s
thoughts and beliefs, and their outward manifestations, to know whether his/her
condition was improving or deteriorating. This means that treatment that is
intended to ‘improve’ Kerry’s condition will also be intended to coerce him/her
to give up or change the ‘false’ beliefs that were the original symptoms of the
illness. So long as Kerry’s delusions remain in an unremitted state it is
likely that the treatment/coercion will continue.

This deduction allows us to establish a prima facie case that any involuntary psychiatric treatment given to a person alleged to have schizophrenia would violate Article 18 by subjecting the person ‘to coercion which would impair his freedom to have or to adopt a religion or belief of his choice’.[19] A further case can be made that the standard neuroleptic drug treatment given to people who are alleged to have schizophrenia does not merely select delusions for modification but also interferes with the person’s freedom of thought by blocking the higher thinking centres of the brain.